During our interventions course, we were introduced to three main intervention types: Cognitive, Developmental and Trauma. I found grouping the course into these three areas to be useful in helping me to understand how to choose the most appropriate intervention for a client issue. It can seem overwhelming to think as a therapist we should 'know what to do' with each client, as every client is different, and their way of relating to the world is different. Our interventions course drove home an important central assumption: "Work in a way that is most suited to the client, and the change they want to create" (Borbridge, 2010a, p.4). It is important to keep this in mind, rather than automatically using the approach the counsellor is most comfortable with.
Here are the three areas of interventions, and criteria on when is the most appropriate situation to use them:
Here are the three areas of interventions, and criteria on when is the most appropriate situation to use them:
Cognitive:
Some examples of cognitive approaches include cognitive-behaviour therapy, narrative therapy and solution-focused therapy. They tend to focus more on the client's thought processes, the language they use, and the stories they tell themselves. "Language is an essential aspect of our human experience...it is an opportunity to examine and re-examine our thoughts, to gain perspective and knowledge" (Borbridgea, 2010, p.3). In her lecture notes, our professor, Corinne Borbridge identified three indicators that a cognitive approach would be appropriate:
1. The client's issues deal with beliefs, habits or cognitions (i.e. negative thinking patterns)
2. The client is not yet ready to deal with other layers of their wounding (i.e. the purely emotional aspect- it can sometimes feel safer to talk and intellectualize problems before delving into the emotions behind it)
3. Other client factors are present, such as language barriers, developmental level or cultural factor that may affect the client's ability to address their issue on a different level (Borbridge, 2010a) Here is a discussion board post from that week's discussion, where we were asked to choose an intervention to apply to case example of a couple who are having issues:
Some examples of cognitive approaches include cognitive-behaviour therapy, narrative therapy and solution-focused therapy. They tend to focus more on the client's thought processes, the language they use, and the stories they tell themselves. "Language is an essential aspect of our human experience...it is an opportunity to examine and re-examine our thoughts, to gain perspective and knowledge" (Borbridgea, 2010, p.3). In her lecture notes, our professor, Corinne Borbridge identified three indicators that a cognitive approach would be appropriate:
1. The client's issues deal with beliefs, habits or cognitions (i.e. negative thinking patterns)
2. The client is not yet ready to deal with other layers of their wounding (i.e. the purely emotional aspect- it can sometimes feel safer to talk and intellectualize problems before delving into the emotions behind it)
3. Other client factors are present, such as language barriers, developmental level or cultural factor that may affect the client's ability to address their issue on a different level (Borbridge, 2010a) Here is a discussion board post from that week's discussion, where we were asked to choose an intervention to apply to case example of a couple who are having issues:
"A cognitive approach I would use with this couple is solution-focused therapy (Cormier, Nurius & Osburn, 2012). One aim of SFT is to focus on the "exceptions to the presenting concerns" (p.525), or the moments when the client is not experiencing conflict. In this case, the couple tend to fight less when the children are not around. I would begin to build my intervention there. I would use constructive questions such as, "what is it about having the children around that causes tension/fighting?". "Is there something about having the children around that disrupts your communication?". I might also make use of the SFT strategy to explore the client's "instead", so I would ask, what about the next time you two begin to argue about having a child together, instead of it leading to a fight, you listen to each other?". I would suggest setting a timer for 5 minutes, where each person is allowed to freely express him/herself uninterrupted. The other person can than relate what he/she heard, to gauge is he/she understands what the other has said. The major aim would be to foster better communication. My understanding of this couple's problems is that they both have greatly differing wants in terms of having children- this could-and is- causing major tension. I think the best place to start is to allow each person to speak and be heard on their feelings around having children. We could practice and debrief this activity in session before they try it at home"
Developmental:
Some examples of developmental approaches include expressive arts therapies, process-experiential therapies and system therapies. The tend to focus more on the client's experiences and how those experiences define their identity as well as their ability to be in a relationship (Borbridge, 2010b). Our ability to be creative, connect with others and express ourselves can deepen our healing process. Here are some ways to determine if a developmental approach would be most appropriate:
1. If there is a 'fragmentation of consciousness' for the client, and would benefit from integrating his/her experiences to create a sense of "whole-ness'
2. If the client is dealing with issues from early experiences from childhood, a time where identities are shape
3. If there are primarily emotional and attachment issues, it is important to incorporate functions of the limbic system, which allows us to attach to others and create relationships (Borbridge, 2010b)
Here is a discussion board post from that week's discussion, where we were asked to use a developmental approach with a client
who had experienced trauma:
Some examples of developmental approaches include expressive arts therapies, process-experiential therapies and system therapies. The tend to focus more on the client's experiences and how those experiences define their identity as well as their ability to be in a relationship (Borbridge, 2010b). Our ability to be creative, connect with others and express ourselves can deepen our healing process. Here are some ways to determine if a developmental approach would be most appropriate:
1. If there is a 'fragmentation of consciousness' for the client, and would benefit from integrating his/her experiences to create a sense of "whole-ness'
2. If the client is dealing with issues from early experiences from childhood, a time where identities are shape
3. If there are primarily emotional and attachment issues, it is important to incorporate functions of the limbic system, which allows us to attach to others and create relationships (Borbridge, 2010b)
Here is a discussion board post from that week's discussion, where we were asked to use a developmental approach with a client
who had experienced trauma:
"A developmental approach that I think would work well with this client is art therapy. A want statement of hers is "I want to feel better, less anxious and be able to return to work". A goal would be to have her return to work feeling confident and comfortable, without major anxiety (it is realistic to expect she will experience some degree of anxiety, and as her counsellor, I would prepare her to accept that, and work with the anxiety). Since the client mentioned that she does not want to spend much time on talk therapy concerning her sexual abuse, I would suggest we do some body work, to help release some of her anxiety. Emotions such as anxiety can become trapped and stored in the body (Rothschild, 2000). I would encourage the client to draw what her anxiety
looks like in her body- where is it stored? what does it look like? what are some associated colours? In this way, she can begin to actualize and express (without words) some of her internalized feelings,thereby releasing the stored pain (Riley, 2004).
The client reported that while she was being abused, she sent messages to her mother, teachers and other adults, and they were all ignored. I imagine this would lead to many feelings of isolation, and that she is not important. I would therefore use the therapeutic alliance to let her to know that what happened to her is important, and we will find a way for her to express it that feels comfortable and right for her."
Trauma:
Trauma was the area I was most excited to learn about, as I had received quite a bit of experience in this area already, on the Rape Crisis Line, as well at through the Assaulted Women and Children's Counsellor/Advocate program at George Brown College. Trauma-related approaches include dialectical behaviour therapy, emotion-focused therapy and body therapies.
Trauma work is a complicated process, and it is important as therapists that we understand how trauma can impact the life of a client (Asgill-Winter & Borbridge, 2010). Trauma can be caused by many different events such as an accident, sexual assault, domestic violence, war or vicarious trauma.
When working with a client who has experienced trauma, the structure is somewhat different than the first two areas.
It is important to first establish safety for the client, as he or she must feel free of danger (at least in the moment) in order to effectively work with the trauma. It is also necessary to build a strong therapeutic relationship, so there is trust between the client and counsellor. Processing the trauma can take a considerable amount of time, and involves stabilization and containment of the trauma, integrating the experience into explicit memory (as opposed to allowing it to remain in implicit memory, and therefore be a threating factor and cause for anxiety) and integration, where the client is able to become fully engaged in their present existence (Asgill-Winter & Borbridge, 2010). Finally, it is important to encourage resilience in the client, as a sense of hope and well-being so he or she can move forward. Here is a discussion board post, presenting how I would work with a client who has experienced trauma:, the same client I focused on in the development lesson:
Trauma was the area I was most excited to learn about, as I had received quite a bit of experience in this area already, on the Rape Crisis Line, as well at through the Assaulted Women and Children's Counsellor/Advocate program at George Brown College. Trauma-related approaches include dialectical behaviour therapy, emotion-focused therapy and body therapies.
Trauma work is a complicated process, and it is important as therapists that we understand how trauma can impact the life of a client (Asgill-Winter & Borbridge, 2010). Trauma can be caused by many different events such as an accident, sexual assault, domestic violence, war or vicarious trauma.
When working with a client who has experienced trauma, the structure is somewhat different than the first two areas.
It is important to first establish safety for the client, as he or she must feel free of danger (at least in the moment) in order to effectively work with the trauma. It is also necessary to build a strong therapeutic relationship, so there is trust between the client and counsellor. Processing the trauma can take a considerable amount of time, and involves stabilization and containment of the trauma, integrating the experience into explicit memory (as opposed to allowing it to remain in implicit memory, and therefore be a threating factor and cause for anxiety) and integration, where the client is able to become fully engaged in their present existence (Asgill-Winter & Borbridge, 2010). Finally, it is important to encourage resilience in the client, as a sense of hope and well-being so he or she can move forward. Here is a discussion board post, presenting how I would work with a client who has experienced trauma:, the same client I focused on in the development lesson:
"This client has had multiple experiences of trauma in her life. She was sexually abused as a child, and even when she expressed it to her mother and other adults, it was ignored. It was allowed to continue for three years. She was also ignored by her mother and stepfather who spent more attention and affection on her brother. The one person she felt close to, her stepfather, has died. I would suspect that her trauma is Rothschild's Type IIB: those who have experienced multiple traumas and who most likely have incurred developmental trauma and have an insecure, disorganized or ambivalent attachment style (Rothschild, 2000). I think that her moving around as a baby into a non-emotionally secure household most likely contributed to an insecure attachment style. It seems that people who were her primary caregivers and the ones who were supposed to protect her, hurt her (and allowed her to be hurt).
So, if I were working with her, I would put emphasis on building a strong therapeutic relationship. It would be important to develop safety early on in our relationship, as is important for those who have experienced trauma (Rothschild, 2000). I like Rothschild’s suggestion of using an anchor- a safe person, or a favorite pet that the client can think about and ‘brake’ when the therapy process becomes overwhelming, and begins to feel unsafe. This could be used during body work, to allow Tricia to pause the process if it becomes too scary- we can then check in and together decide how to proceed".
Professional Development Presentation:
During our interventions course, we were give the opportunity to learn about a specific intervention in-depth. Because of my interests in trauma-related approaches, I chose to study Dialectical Behavioural Therapy (DBT). DBT is an approach that is effective with clients experiencing borderline personality disorder. I had the opportunity to work with two of my peers from the program who brought a great breadth of knowledge and clinical experience to this project. Here is the 'handout' we created for our class presentation, which provides an overview of DBT:
During our interventions course, we were give the opportunity to learn about a specific intervention in-depth. Because of my interests in trauma-related approaches, I chose to study Dialectical Behavioural Therapy (DBT). DBT is an approach that is effective with clients experiencing borderline personality disorder. I had the opportunity to work with two of my peers from the program who brought a great breadth of knowledge and clinical experience to this project. Here is the 'handout' we created for our class presentation, which provides an overview of DBT:
Here is the power-point presentation we created:
Finally, during my time as a counselling intern at York University's Personal Counselling Services, I had the opportunity to practice two different approaches to counselling, including Client-centered therapy, as well as Cognitive-behaviour therapy. These are approaches I enjoy working with, and will be useful for me throughout my career. I look forward in the future to gaining experience in more specific types of interventions, such as DBT and mindfulness. I expand on how I will go about this in my "Future Aspirations" section.
References:
Asgill-Winters & Borbridge, (2010). EDPS 638: Week 6: Intervention: Trauma An overview of trauma: Theory and Practice [PDF File].. Retrieved from EDPS 638: https://blackboard.ucalgary.ca/webapps/portal/frameset.jsp?tab_id=_2_1&url=%2fwebapps%2fblackboard%2fexecute%2flauncher%3ftype%3dCourse%26id%3d_151823_1%26url%3d
Borbridge, C. (2010a). EDPS 638 Week 4: Intervention: Cognitive structure, process and outcome of cognitive ‘talk therapy’ approaches [PDF document].
Retrieved from EDPS 638 course website: https://blackboard.ucalgary.ca/webapps/portal/frameset.jsp?tab_id=_2_1&url=%2fwebapps%2fblackboard%2fexecute%2flauncher%3ftype%3dCourse%26id%3d_151823_1%26url%3d.
Borbridge, C. (2010b). EDPS 638 Week 5: Intervention: Developmental injuries and experiential approaches.[PDF document]. Retrieved
from EDPS 638 course website: https://blackboard.ucalgary.ca/webapps/portal/frameset.jsp?tab_id=_2_1&url=%2fwebapps%2fblackboard%2fexecute%2flauncher%3ftype%3dCourse%26id%3d_151823_1%26url%3d
Cormier, S. Nurius, P.S. & Osburn, C.J. (2012). Interviewing and change strategies for helpers: Fundamental skills and cognitive-behavioral interventions,
7th Edition. Belmont, CA: Brooks/Cole.
Rothschild, B. (2000). The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment. New York NY: W.W. Norton & Company
Riley, S. (2004). The creative mind. Art Therapy: Journal of the American Art Therapy Association, 21(4), p. 184-190